Pregnancy-like (pseudolactational) hyperplasia: uncommon cause of microcalcifications and mass in two cases.

Pregnancy-like (pseudolactational) hyperplasia (PLH) is an uncommon lactational change occurring independently from pregnancy and lactation. PLH has been incidentally found during breast biopsies. We report two different cases of PLH with their clinical, radiologic, and pathologic findings.

The immunohistochemical detection of P16 and HPV L1 capsid protein on cell block sections from residual PapSpin liquid-based gynecology cytology specimens as a diagnostic and prognostic tool.

BACKGROUND: Immunohistochemical staining for p16INK4a (p16) and HPV L1 capsid protein (HPV L1) are a useful ancillary technique for diagnosing preneoplastic lesions of the cervix in histologic specimens. The purpose of the current study was to examine the usefulness of p16 and HPV L1 immunolocalization in PapSpin Liquid-Based Gynecology Cytology Specimens (PapSpin cytology) derived cell block material in the diagnosis and prognosis of preneoplastic lesions of the cervix. METHODS: The cervical cytologic smears of 64 patients who underwent colposcopic biopsy our Center were retrospectively evaluated. The cervical cytologic smears have been previously assessed by the PapSpin cytology and cell blocks were prepared from these samples. Immunohistochemical staining p16 and HPV L1 was performed on paraffin-embedded cell blocks of 64 PapSpin cytology specimens. RESULTS: The positive staining of the cell blocks for P16 was directly proportional to the degree of intraepithelial lesion. In cases with squamous cell carcinoma (SCC) and high grade squamous intraepithelial lesion (HSIL), the positive staining of p16 was found to be statistically significant. In contrast, with the increasing degree of the lesion, a statistically significant decrease was observed in the HPV L1 positivity. CONCLUSIONS: Immunohistochemical p16 and HPV L1 studies on cell block may increase the diagnostic accuracy of cervical cytology. When p16 and HPV L1 are immunohistochemically applied together on the cell blocks, they can provide information about the prognosis of cervical intraepithelial lesions.

Intramedullary spinal cord metastases: diagnosis and treatment - an illustrated review.

BACKGROUND: Intramedullary spinal cord metastases (ISCM) are rare but, with increasing use of magnetic resonance imaging (MRI) are being encountered with increasing frequency. Optimum treatment remains controversial. On the basis of a review of previous reports and experience with a patient with an ISCM from a large cell lung cancer, we propose practical diagnostic and therapeutic approaches. FINDINGS: We found 284 patients who had an Intramedullary spinal cord metastasis reported in English literature up to February 2004. 32 had been treated surgically. The mean survival in these patients was two times longer than in those treated by a conservative approach. Improvement and prolonged survival occurred in patient we treated by microsurgical dissection of the metastasis. CONCLUSION: Early diagnosis and early surgical resection can result in improvement in neurological deficits and in the quality of life of patients with a Intramedullary spinal cord metastasis.

WITHDRAWN: Microsurgical resection of intramedullary spinal cord metastases of large cell lung cancer.

This article has now been withdrawn and will not appear in print.

Location and length of arteriovenous fistulas around axial-pattern skin-flap pedicles.

The importance of the location of a surgically-created arteriovenous fistula around the pedicle (both distal and proximal) on the viability of rat skin flaps was investigated. The animals were randomly divided into four groups. Group 1 included bilateral standard island groin flaps. The right side flap was used as a control. On the left side, after elevation of the flap, an X-type arteriovenous fistula greater than 1 mm (up to 2 mm) in length was created distal to the pedicle, and just before the bifurcation of the common femoral vessels. In Group 2, the flap was an axial-pattern medially-based peninsular flap, including the same vessels. In this group also, two flaps were elevated bilaterally, and the right side was used as a control; on the left side, an X-type arteriovenous fistula the same length as in Group 1 was also created distal to the pedicle. In both groups, all other branches of the common femoral vessels were kept intact. In a second part of the study, two other animal groups were used to clarify the importance of the length of the arteriovenous fistula on the viability of skin flaps. In Group 3, the model was the same as in Group 1, but the fistula was 1 mm in length. In Group 4, the length of the fistula was 1 mm, and its location was on the common femoral vessels proximal to the pedicle, using the same flap model. Flow values were measured repeatedly using a laser Doppler flowmeter. Histopathologic studies were also done. There are three important points arising from these studies. 1). The location of an X-type arteriovenous fistula around an island skin flap pedicle seems to be more important than diameter. An arteriovenous fistula proximal to the pedicle is more hazardous than an arteriovenous fistula distal to the pedicle, regarding island skin-flap viability. 2). However, the length of the fistula is also important, and an arteriovenous fistula distal to the pedicle, with a sufficiently long length, is not devoid of harmful effects. It is also clear that the larger the fistula, the greater the systemic effects. 3). An island skin flap with an arteriovenous fistula distal to its pedicle might be a useful model to study the relationship between skin-flap viability and edema formation.

Viability of diced, crushed cartilage grafts and the effects of Surgicel (oxidized regenerated cellulose) on cartilage grafts.

The viability of cartilage grafts has been well documented; however, controversy still exists about the viability of crushed cartilage. Recently, there has been a tendency to use diced cartilage grafts wrapped with oxidized regenerated cellulose (Surgicel) sheets for improving dorsal contour in rhinoplasty. The viability of diced cartilage grafts and the effect of Surgicel on cartilage grafts are not well known. In this study, we used ear cartilage from 18 New Zealand rabbits. Cartilage grafts were transplanted to surgically created subcutaneous pockets on the back of the rabbits on both the left and right sides. There were three groups: (1) intact cartilage grafts, (2) crushed cartilage grafts, and (3) diced cartilage grafts. The grafts that were transplanted to the right side were wrapped with Surgicel. Cartilage grafts in all groups were viable. In grafts that were wrapped with Surgicel, a marked increase in the collagen content was investigated. Grafts that were wrapped with Surgicel demonstrated no evidence of proliferation, whereas the bare cartilage grafts demonstrated significant amounts of proliferation.

Extensive lymphatic malformation of penis and scrotum.

Lymphangioma circumscriptum is an uncommon condition of the skin and subcutaneous tissues characterized by localized patches of vesicles. The penoscrotal region is a rare site for its development. We present a case with an extensive onset of lymphatic malformation of the pubis and penoscrotal region that we treated with wide excision. Reconstruction was achieved with a split-thickness skin graft combined with residual scrotal skin advancement.

An unusual cause of renal colic: hydatiduria.

Hydatid disease of the urinary tract is seen rarely. Hydatiduria may be a finding of renal involvement, but it is a rare cause of renal colic. A case is reported of renal hydatid disease that was diagnosed during the investigation of renal colic. A 38-year-old woman presented with renal colic. She had a history of episodes of renal colic and occasional voiding of grape-like material. No calculus was found in the urinary tract by plain film or ultrasonographic examination. The histopathologic examination of this material revealed daughter cysts that are pathognomonic for hydatid disease. Ultrasound and computed tomography confirmed this diagnosis and right nephrectomy was performed without cyst perforation or any spilling of cyst content. Albendazole, 10 mg/kg per day, was given for 4 weeks (2 weeks preoperatively and 2 weeks postoperatively).

Initially alloperfused autograft: an experimental study with rat groin free flap.

The purpose of this experimental study was to investigate the effects of alloperfusion on autografts. The authors designed an experimental model to study flap viability during and after alloperfusion. They performed 23 free groin flap transfers on 46 rats. The flap was transferred as an autograft; however, the anastomosis was performed as an allograft procedure. After the operation, animals were held together on a table for observation. The rats were randomly divided into two groups depending on whether or not a steroid was given. They were fed by hand. At the end of the various waiting periods, the pedicles were divided, and animals were separated from each other. The survival of the flap and the animal was observed. No flaps survived in the untreated group. Seven flaps in the steroid-treated group that had their connections cut before 140 hours also did not survive. Five flaps that had their pedicles cut after 140 hours survived. Results are presented and discussed.

Intracerebral malignant fibrous histiocytoma in a 5-year-old girl.

A case of primary intracerebral malignant fibrous histiocytoma (MFH) in 5-year-old girl is presented, the eighteenth case so described in modern literature. A lobulated, heterogenous mass lesion with a haemorragic component was present in our case' s MRI. A review of the literature on MFH of the pediatric age group was done to establish guidelines for standard treatment modalities in primary intracerebral MFH.

Surgical management of penoscrotal lymphangioma circumscriptum.

Lymphangioma circumscriptum of the penis and scrotum is an unusual entity that may be indistinguishable from genital warts. After confirmation of the diagnosis, a treatment plan consisting of wide excision should be outlined. To lower the chance of recurrence, not only the affected skin but all the subjacent subcutaneous tissue, including the deeper components of the lymphatic malformation just above the deep fascia, should be removed.

The effects of tissue expansion on skin lymph flow and lymphatics: an experimental study in rabbits.

Histomorphological, physiological, and biomechanical changes of the skin and tissue that are being expanded have been extensively studied in the past. The purpose of this study was to investigate whether the skin lymph flow and lymphatics may be influenced during tissue expansion, and also to study different pattern of vascular supply of skin on lymph flow during tissue expansion. The skin lymph flow was quantitatively assessed by 99mTc-dextran lymphoscintigraphy, and the structure of dermal lymphatics was evaluated by histological examination in 12 rabbits. Lymphoscintigraphic results showed that lymph flow is significantly reduced both in expanded and non-expanded (sham-operated) skin. Histologically, we saw widespread lymphatic distension in both expanded and non-expanded skin. There were no quantitative differences in the number of lymphatic vessels compared with control skin. We did not see any lymphatic capillaries in the subdermal capsule of either expanded or non-expanded skin. These results show that lymphostasis has an obstructive (mechanical) aetiology, and the tissue expander itself reduces the lymph flow regardless of expansion, and interferes with the formation of new lymphatic vessels.